Inflammation is the foundation for cancer and degenerative/autoimmune diseases. Small changes in diet and exercise, e.g. omega-3 oils, vitamin D, low starch, and maintaining muscle mass, can dramatically alter predisposition to disease and aging, and minimize the negative impact of genetic risks. Based on my experience in biological research, I am trying to explain how the anti-inflammatory diet and lifestyle combat disease. 190 more articles at http://coolinginflammation.blogspot.com

Anti-Inflammatory Diet

All health care starts with diet. My recommendations for a healthy diet are here:

Tuesday, June 23, 2009

These are my generalizations (some would say prejudices) from 40 years of experience in plant biochemistry and molecular biology:

Plant Secondary Compounds Are Defensive and Toxic

The development of plant secondary compounds (all of the compounds that are not part of metabolism or structures) is in response to pathogens, herbivores and pollinator/disseminator attractants -- development of these compounds has nothing to do with humans. Examples: Nicotine and caffeine are very toxic to herbivores and are present in plants for protection. Humans learn to play with toxic plant chemicals, just as they have learned to play with fire and explosives.

Plants Are Not There For Us

People have learned to exploit local plants for protection against local human pathogens, but there is no selective advantage to plants (except for domesticated plants) for useful plants to grow near humans. This logic would suggest that rats and mosquitoes, that flourish near human habitations, are there because of their human utility. Human live near places were useful plants grow.

Grains Are Unhealthy

One of the biggest problems with food processing is separating the inflammatory parts = starch and omega-6 oils, from the nutritive parts, the so-called anti-oxidants, vitamins, proteins, etc. Grains, even so-called whole grains, are simply too enriched for starch and inflammatory oils to be healthy. They are not safe to eat in large amounts. Leafy plant parts are healthy, but even those parts are not good in large amounts from a single plant species. Humans are browsers, because the plant secondary compounds are uniformly toxic, but can be tolerated better in a mixture of different toxicities.

Starch Is Inflammatory

Starchy foods should be treated like a fish. The starch should be pared away and discarded, like the fish gut and bones. (The guts and bones could actually be processed to make them nutritious. Not so with the starch. The starch should be fermented.) The potato skin should be eaten and the rest discarded, just as an aphid secretes as honey dew the extra sugar it sucks in from a plant leaf.

Cereals Are Inflammatory

Breakfast cereals are a dietary abomination. They contribute immensely to obesity, inflammation and chronic disease. Oatmeal for cardiovascular health is a total fraud. The fiber might be useful, but the high starch causes cardiovascular disease. Grains/cereal are the foundation of the chronic disease pyramid.

Fructose is Toxic

Fruit juices are another fraud. The juice (fructose) should be removed and discarded. The fructose is very unhealthy. Mice are given type II diabetes for research purposes by feeding them fructose (especially high fructose corn syrup.) Fructose is avoided in the beef industry, because it causes rapid cross-linking of collagen and leads to tough meat. The same thing happens in humans who eat fructose, it causes aging of the skin and other tissues. High fructose corn syrup is a commercial addiction -- it is hugely profitable as a sweetener -- and that is why it is still used, even though it is grossly unhealthy. It will eventually be removed from the market after the industry is protected from subsequent law suits. It is equivalent to the tobacco industry -- too lucrative to eliminate.

Phytic Acid

The active ingredient in fiber that provides its benefits is phytic acid, the same chemical that people are trying to eliminate. Phytic acid acts as a chelator. I don't think it is actually a problem. The problem comes from extracting cations from the phytic acid before it is eaten. Phytic acid should go in saturated, so that it doesn't contribute to deficiencies. The actual problem is that the diet is already low in minerals, because of eating processed foods that are mineral deficient.

Enzymatic Detoxification: P450, Glycosylation and Secretion

Humans are adapted to plant secondary metabolites by the abiltiy to enzymatically detoxify [using p450 and glycosylating (adding glucuronic acid)] and secrete the toxic compounds. These chemical modifications that occur in the intestines and liver are usually effect. They also work on drugs and that is how we eventually clear these compounds from our systems. Grapefruit and black pepper inactivate these enzymes and alter the way we metabolize plant toxins and drugs. The detox enzymes can also convert innocuous compounds into toxins and carcinogens. That conversion is the basis for using liver enzymes in the Ames Test for carcinogens. The activity of the enzymes is dependent on recent diet, so it would make sense to gradually change the amount and type of vegetables that are eaten in a meal to permit the detox system to adjust.

Glucose and Insulin Cause Fat Accumulation

Fat accumulation is dependent on dietary carbohydrates and insulin. Fat and serum lipids accumulates with a high carbohydrate diet and decrease on a low carbohydrate diet. This is more important than the number of calories consumed.

Inflammation Not Serum Lipids Cause CVD: Statin Are Unnecessary

Inflammation is the source of chronic degenerative diseases. Serum lipids are only secondary factors. Statins lower serum lipids, but do not impact cardiovascular health unless they also lower inflammation. Lowering inflammation lowers serum lipids and decreases cardiovascular disease. Statins appear to be a very expensive way of treating cardiovascular disease dependent on their side effect on inflammation. Modest dietary and lifestyle changes are much more effective, cheap and safe than statins.

55 comments:

But why do you say that starch is inflammatory? Hyperglycemia and hyperinsulinemia are inflammatory, but what evidence is there that starch is inflammatory for someone on a low-carb diet?

I eat no more than 100 gm of carbohydrate per day, not counting vegetables, and I frequently eat rice or potatoes to reduce the amount of fructose I eat. I would appreciate any references or evidence you might have that this is inappropriate.

You are quite correct. There is nothing inherently wrong with starch. I was merely being hyperbolic for clarity. Most people eat starch the wrong way. Starch is part of the Mediterranean diet, but does not lead to chronic inflammation, because the way it is eaten does not lead to hyperglycemia or hyperinsulinemia.

Starch is immediately hydrolyzed to glucose for uptake in the intestines. In even moderate amounts it produces a blood sugar rise, an insulin increase and inflammation. I was pointing out that starch is a major health problem in many modern diets. Look at the ridiculous food pyramid. It is inflammatory and unhealthy.

For most people, I think that there are no ill effects from eating up to 50 gm of glucose (usually as starch) at a meal. A bowl of cereal and a piece of toast would be inflammatory.

The daily total that you have of 100 gm of carbs is great, as long as there isn't enough in one meal to cause an insulin rise. Early morning after a night of low blood sugar, it is especially healthful to slowly increase blood sugar. The cereal breakfast would be a bad choice and would begin a whole day of high insulin and hunger.

Potato peels are disproportionately nutritious, agreed, but they are also disproportionately toxic. That's where most of the glycoalkaloids are that can increase intestinal permeability in susceptible rats at normal dietary levels. If you look at traditional cultures that subsisted on potatoes, they peeled them. I think it's wise to respect the accumulated wisdom of the Peruvians who have been eating them for some 6,000 years. Of course that becomes more important if potatoes are a caloric staple.

The second thing has to do with phytic acid. It's never really saturated with minerals, even in unrefined grains. Phytic acid prevents more than half of zinc absorption up to a PA:Zn molar ratio of about 5. Normal whole grains are 30 or higher. The only thing that really makes whole grains a good source of minerals is fermenting them, soaking in the case of freshly ground gluten grains, or enzymatically dephytinizing them. Refining grains actually decreases the PA:Zn ratio and paradoxically improves mineral availability.

Adding whole grains or bran to a meal decreases the overall absorption of certain minerals from the meal, despite the fact that whole grains and bran are full of minerals. Rats are not a good model organism for studying this because they produce phytase in their small intestine. That's what you'd expect from an animal that is adapted to eating cereal grains if phytic acid is problematic overall. Humans produce about 1/30th the phytase of rats, necessitating processing methods that reduce PA for good mineral status if whole grains are consumed as a staple.

Hi Stephan,I grant that you are more familiar with the phytic acid studies than I am. I find it hard to believe that phytic acid is another antifeedant directed at herbivores. The mechanism of Zinc chelation is not straightforward and still seems a flaky problem to me. I guess that the presence of phytase in grain eaters is substantiating evidence, but it still seems unconvincing.

The signaling properties of inositol (phytic acid is inositol hexaphosphate) with various phosphorylations, e.g. IP3, should not be ignored during the metabolism of phytic acid.

I claim varietal differences to discuss the potato alkaloid issues. I don't have a profound position. I was only attacking high carb diet and potatoes were a convenient target. Potatoes are far from equal and the Burbank potato does not grow in Peru. I happen to live in Idaho, the land of the MacDonald's Burbank high starch fries. I would guess that the alkaloid and starch of the Burbank make my remarks close to valid. I would not expect the same to be true of the thousands of Peruvian potato varieties.

I'm not opposed to your view that PA is not a toxin directed at animals. It could just be a way to keep minerals from diffusing out of the seed when it inevitably gets wet.

I'm open to the idea that PA may have some benefits. I just think ensuring mineral status is higher on the list of priorities. If you eat a high-mineral diet or eat modest amounts of PA-rich foods, it probably doesn't matter.

I'm not totally convinced that potato glycoalkaloids are a problem in small amounts, but it's something I'm keeping my eye on. I suspect it may be able to exacerbate compromised intestinal permeability caused by other things.

Very interesting article as always. I am a devotee to anti-inflammatory principles and have tried to incorporate the philosophy into my diet.

I was a little concerned to read that black pepper inactivates useful enzymes. I have a daily consumption of ground black peppercorns in my food. Perhaps up to a third of a teaspoon a day. How could this affect my toxin elimination? I use black pepper because I thought it was an anti-inflammatory, and had a positive enhancing effect when consumed with turmeric/chillie pepper.

Pepper components (piperine) partially inactivate the glycosyl transferase that adds glucuronic acid to aromatic dietary compounds, such as curcumin, the active anti-inflammatory ingredient in turmeric. Pepper and turmeric is a time-honored combination, probably because it was found to make people healthier.

Pepper is one of the few dietary supplements effective in reducing inflammation associated with obesity.

Pepper seems to enhance the anti-inflammatory effects of other spices, so I recommend it.

I don't worry about phytochemicals, unless I start to use them medicinally (special concoctions to treat particular ailments.) At that point I think that phytochemicals can become harmful and advice on traditional use is needed.

I am just trying to debunk the idea that plants are natural and safe. I would say that meat (free range) and water are safe, but not plants. I prefer to let the livers of other animals suffer the toxic effects of the plants and pass the nutrients on to me.

Stephan,Back to phytic acid. I think that PA is like a bacterial siderophore. Bacteria secrete chemicals, e.g. enterobactin, that bind iron more tenaciously than EDTA. The siderophore-iron complexes then bind to transport proteins on the surface of the bacterial outer membrane and are moved inside. The siderophore-iron complexes are not available to other organisms. Part of the human innate immune system is the production of siderocalin that binds and internalizes siderophore-iron complexes. Siderocalin has a very strong quartet of basic amino acids consistent with nuclear translocation. Interesting, no?

Phytic acid is probably used in a similar way by plants. It is secreted, picks of divalent cations and then I would expect that plant have a phytic acid-cation transport system to take up the ions. I would also expect some animals to have a similar transport system, instead of simply dephosphorylating the phytic acid. Human probably cultivate gut flora to do this for them. The answer to phytic acid in grains is probably prebiotics/probiotics.Art

Phytic acid may also be beneficial for treatment and prevention of cancer. Here's a good summary article: http://jn.nutrition.org/cgi/reprint/133/11/3778S. The authors suggest that PA does not cause mineral deficiencies when taken as a supplement by individuals with otherwise proper nutrition.

I know it is anathema to your philosophy (both Stephan and Dr. Ayers), but perhaps IP-6/inositol supplements should be considered by people with elevated cancer risk. An anti-inflammatory diet may be sufficient for most, but if I was positive for BRCA genes, had a history of smoking, had Barrett's esophagus, or some other risk factor for cancer, I think I would consider hitting the harder stuff. Thoughts?

Dan,I certainly plead guilty to trying to shoehorn all of medicine into a single conceptual framework/philosophy. I find that to be a powerful, though dangerous, approach.

Anti-inflammation at all costs is, I think, a reasonable first approximation in a context that is so destructively inflammatory. It teaches that dietary inflammation is a big problem and perhaps the problem in the U.S. healthcare collapse.

Anti-inflammation does, however, overlook the problem of the underlying sources of inflammation, outside of diet, that increase with age.

I think that we need to look to our resident bacteria: gut flora and chronic microinfections. Pre/probiotics is in its infancy and will continue to support improved health. Pathogens in small colonies throughout the body inducing tissue dormancy/hibernation will, I think, become the next big target. That is heresy with the current medical paradigm, but the evidence is mounting.

I think that some persistent states based on inflammation, cannot be destabilized by diet alone. More aggressive approaches are needed. The current systems for monitoring inflammation are inadequate. For example, they do not give information on the sources of inflammation. The composition of bound serum heparanoids might me more informative. I don't know if there is an anti-inflammatory state beyond not inflamed, that might be useful for people with genetic risks. My feeling is that genetic risks become irrelevant in the absence of chronic inflammation.

Phytic acid, IP6, and all of its relatives IP(1-5) are an interesting bunch. I feel obliged to point out that heparin injected into neurons blocks IP3 signaling, because the IP3 binding domain is a heparin binding domain. The cyto side of transmembrane signaling molecules, e.g. syndecan 4, have strong heparin binding domains, that also bind to the IP lipids and promote cyto transport of vesicles with the membrane proteins toward the nucleus. The carrier is probably related to nuclear localization. IP6 may be internalized by proteins with multiple heparin binding domains using the heparan sulfate proteoglycan recycling system (HSPGs have a half life of 6 hours on the surface.)

I see what you mean about PA as a mineral transport molecule, that's interesting.

The siderophore-iron thing is interesting too. Dr. Michael Eades has noted that blood iron drops during illness. Maybe that's the siderocalin transporting all the siderophore-iron complexes out of the bloodstream. I had a friend whose doctor told him he was anemic. He had none of the symptoms, so I asked him if he was sick when he was tested and he said yes. He got tested the week after and his blood levels were normal.

I just remembered an interesting study in which the near-vegetarian African Kikuyu tribe had a prevalence of rickets of 63% while the milk-blood-meat Maasai had essentially no rickets. Both got plenty of vitamin D from sunshine, which suggests mineral deficiency in the Kikuyu.

The Kikuyu traditionally ate whole grains (sometimes fermented I believe), legumes, starchy tubers, fruit and vegetables, with small amounts of meat, dairy and insects when available. They are an extreme case, granted, but it does show that excessive reliance on PA-rich foods is dangerous.

Dan, I think supplementing with extra phytic acid is probably not a good idea. But its effects on mineral absorption are lessened in the presence of meat, dairy and vitamin C.

i'm wondering if you think in some instances that fructose-based products (such as a basic grapefruit) are ok to consume and not necessarily pro-inflammatory.

for example:

http://care.diabetesjournals.org/content/30/6/1406.full.pdf

this journal article shows how higher levels of naringenin (a flavanoid in citrus fruits) inhibits ROS, and that eating the fruit doesn't necessarily generate ROS even though it has higher levels of fructose.

i understand your concern about processed foods and HFCS, but i'm trying to clarify your viewpoint.

2. Toxic Secondary Compounds

It seems to me that there is a very credible thesis that a lot so-called toxic plant chemicals induce metabolic defenses. The concept of 'xenohormesis' as briefly outlined here by D. Sinclair

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2504011

explains how low-dose toxins are actually beneficial over the long-term. that which does not kill us, makes us stronger.

3. i'd be curious to know what you DO eat. i understand what you don't eat, but i think it'd be interesting for your readers to see a sample diet of what you've had over a day or week, etc.

i realize this is not an online cooking class, but i am personally curious.

I think that if we want an overview of defense strategies, we can generalize from eggs, seeds and milk. All of the innate and inducible systems are present in those examples, but there are hundreds of different components.

The Kikuyu example is very neat, but my prejudices say that all deficiencies ultimately elicit inflammatory responses. The diet is inflammatory even without invoking mineral deficiencies. I would say that chronic inflammation was decreasing vitamin D production. I don't know if anyone has studied the impact of inflammation on vitamin D production. There was a metastudy of some 200 different studies of omega-3 fats on mental disabilities. The conclusion was that no one bothered to control the omega-6 oils in the diets and all were compromised. Variability in inflammation in subjects is a massive problem in many different types of studies.

Fructose - I think that a little now and then is no big deal, but one can of fruit nectar (with added HFCS) will have a lasting impact. I just don't think that fruit juices on a regular basis are healthy. Fruit juices are not safe for kids. I think that it would make more sense to make your own vegetable juices.

Phytochemicals - I don't think that you have to go out of your way to challenge your immune system with phytochemicals. All you have to do is eat some veggies with your meat.

My diet - This is very intimate. I don't know if I should reveal my personal weaknesses. I will write a post with some recent meals to give an idea of how I handle my food.

I got here by following your request on another blog. I find your comments to be utterly utterly brilliant ... especially since they coincide with my own prejudices.

I agree with you that most plant parts did not evolve to benefit us. In fact, quite the contrary. But wouldn't you agree that the fleshy portion of fruit co-evolved with animals, including us, and that fruit is a very nutritious part of our diet?

In my case, I tend to eat a lot of avocados, as well as non-sweet fruit like tomatoes, and red/orange/yellow bell peppers.

That was an insightful comment you made about inflammation decreasing production of vitamin D.

Celiac patients have very low D levels which are completely reversed in 6 months on a gluten-free diet.

There was a controlled trial where feeding wheat bran to volunteers caused them to burn through their vitamin D stores at a 30% faster rate than normal (statistically significant). The study was small and should be replicated.

So I'm not sure inflammation actually interferes with the synthesis of D, but it does seem to degrade it at an accelerated rate. In any case, the effect is the same.

Dr. Edward Mellanby (discoverer of vitamin D) felt that cereal grains antagonize fat-soluble vitamin action. His experiments showed that phytic acid is the compound that antagonizes vitamin D, but he also felt grains antagonized vitamin "A" (which at the time was often a combination of A and K2).

I've also independently gathered hints from the literature that his hypothesis is correct (I felt it was true even before I read his work). As far as I know, no one has ever pursued that line of investigation to discover the compound(s) in cereal grains that may antagonize the other fat-soluble vitamins.

I pose as anti-fruit or fruit juice, simply to awaken people to the dangers of fructose.

I do know better, even though I write about fruit as if they only included those laden with fructose. I support all of the veggie stuff except the starch and fructose. Avocados and peppers are great.

Tomatoes seem to be particularly healthful and I enjoy tomato stew (no HFCS, check the can or make your own) with a poached egg, turmeric, pepper and olive oil, for breakfast. Keep all of the carbs less than 50 gms and watch the toast. I occasionally add a couple of strips of bacon and worry more about the carbs than the calories.

I have green or black tea without sweeteners, or a shot of freshground espresso (half decaf) in 6 oz. of whole milk. Keep the flavored syrups to a severe minimum and avoid any fructose.

I sometimes grate a whole potato, squeeze out a lot of the liquid and press it into a thin pancake on a hot non-stick skillet with olive oil. It is delicious browned on both sides and salted. Freshly crushed garlic can be pressed into the surface before it is turned. It is very difficult to eat just 50 gm of carbs, but more will make you hungry and be inflammatory.

personally, i drink some OJ or pomegranate juice rarely. i drink mostly tea/water.

i was talking about fructose in the context of a fructose containing fruit like a whole orange fruit. some life-extentionists/health nuts are pretty paranoid about fructose to the point where they avoid oranges.

i guess i need to find a study that contrasts processed fruit juice vs. the actual raw fruit and their inflammatory/ROS impact.

re: your diet.

i don't think you need to give all the gory details of your personal diet. everyone has their own vice. i meant just more like an ideal day. perhaps, what you aspire towards rather than the actual detailed diary.

Interesting topic as always. Since the subject of diet came up, I try to follow the Zone anti-inflammation diet. If there's a problem with it, it's that it doesn't seem to give me enough energy. Near the end of the week I have bouts of hypoglycemia. I suppose I could cut back on my daily running but for me that would lead to other problems.

My experience with the Zone diet is similar. There is actually no justification for the amount of carbs that are in that diet. I think that it still produces an insulin rise and hypoglycemia. That is what the diabetic experts would predict.

The low carb crowd recommends less that 50 mg of carbs (readily available as glucose, e.g. starch) in a meal. Exercise can be used to lower the impact of a glucose surge.

I, and most others, have much more sustainable energy on a low carb diet. Fats are a more reasonable source of energy. I don't think that the biomedical literature provides a convincing case for any unhealthy aspects of saturated fats. Vegetable oils and carbs have been shown to cause inflammation, obesity and provide the foundation for degenerative diseases.

In summary, the Zone diet provides a good biochemical explanation for the role of food in inflammation, but the diet itself seems to me to still be too carb-rich and inflammatory. I think they also may have, at least initially, underestimated the pervasiveness of vitamin D deficiencies.

Bill,I don't see your good/bad carb reference in this context. My understanding of the good/bad carb idea is nothing more than saying that a rapid rise in blood sugar triggers insulin production. High blood sugar is a problem because the glucose glycates proteins to produce inflammatory AGE (advanced glycation end products.)

The olive oil should be independent of the carbs. The oil will only contribute to body fat if you also eat enough carbs to raise your blood glucose and insulin, so that the glucose level in fat cells rises. The fat cells can then produce enough phosphorylated glycerol to produce the triglycerides stored as fat. Without high blood sugar and insulin, there is no fat storage.

I'm sorry to belabor this thread but I have a problem with the last statement. Where does the fat go if it isn't absorbed. If 10,000 calories of fat doesn't end up in the toilet, where is it going if not into fat storage. Guyton's text on medical physiology says fatty acids diffuse into fat cells, no insulin required. Insulin helps carbohydrates to enter cells but fats enter by a counter-current mechanism. So when blood is lipemic the fatty acids are saturating the blood and being used or stored as fat, not sent back into the intestine to end up in the toilet.

Kevin,I have the same thoughts about this apparent dilemma. Obesity to me is a form of malnutrition in which circulating triglycerides (LDL) stick to the surface of fat cells, are converted to fatty acids, transported across the cytoplasmic membrane (they can't diffuse across) and use activated glycerol to make phospholipids or triglycerides. The triglycerides are stored and continuously recycled in the cell to fatty acids.

If there is enough glucose in the fat cells, the fat will remain as triglycerides. If there is a limiting amount of glucose in the fat cells, then the equilibrium in the cells will yield excess fatty acids and the fat cell will start to export. This suggests that there is a mechanism for export of fatty acids and not triglycerides.

As you point out, it seems that the only place the lipids can go is the liver and from there, the only place it can go is to bile and out of the body as feces.

In malnurished populations, the babies are lean, but many of the adults may be obese. The poor food quality is just carbs. As a result the adults become lethargic and all body components are converted to body fat. Diabetics without insulin are just the opposite -- no fat is stored.

That would mean that in eating 1000 ml per week of olive oil, more than 100 ml per day would be going down the toilet. Seems a waste.

My WiFi extends to my garden and it is too inviting to just sit under my redbud tree, with my MacBook Air in my lap, listen to the bees, enjoy a cup of rich coffee, nibble on a square of dark chocolate, and respond to comments like yours on my blog.

I have been teaching college students for 30 years and it is difficult to avoid responding to questions or to seeking new insights in naive comments. It is very pleasant to just contemplate a very beautiful conceptualization that blends seamlessly with the real world. My daily walk along Indian Creek can wait for a few moments.

I have an organic apple with 2 or 3 cups of coffee in the morning.Late morning I fry 2 omega 3 rich organic eggs in 50cl of evoo. I add a generous amount of freshly ground black peppercorn and a third of a teaspoon of turmeric. I add about 40 grams of tomatoe purée, then pour the olive oil and mix up.I have totally eliminated grains, sugar and added salt, so my logic is that I benefit from the antioxidants from the evoo and the oil sates my appetite. (I used to love bread with eggs.) I had assumed that the oil gave my body the calories for energy. I find that I rarely feel hungry all day and normally eat nothing until late afternoon, and this will probably be some walnuts, brazil nuts and dried prunes or maybe 2 pieces of 90% cocoa chocolate.

I have been eating like this for almost 3 years. My weight has dropped from 155 pounds.I have little body fat. I am 6 foot tall and weigh 140 pounds for the past 6 months. Even if I increase my intake of food, (within my regime), I cannot gain weight. I am 55 and walk 30+ miles a week. I am looking to gain muscle mass and strength, especially my upper body. My weakness is full bodied high tannin red wine. I probably drink more than the RDA, but again this does not affect my weight. I used to love beer, but now totally abstain.

I have to live within my means, otherwise for protein I would include game and pastured organic meat. I would also use pastured animal fat, as long as the omega 3-6 balance is good, as an alternative to the evoo.

I never tire from eating like this. The preparation can be a drudge but I have maintained this for more than 800 days with less than 3% lapses. I never eat processed foods, but within the lapses I may have eaten industrial meat, such as store bought spit roasted chicken.

If the evoo goes down the toilet, then sobeit. Just as long as the high consumption has no detrimental effects on my body.My meals are avidly consumed by friends and family. I believe the high evoo content makes the meal more palatable. Could this be considered as "healthy" fastfood?

Bill,You diet seems to be very healthy, but you are thin. The large amount of EVOO is unconventional, so I don't know if it is a problem.

Your diet does illustrate the disconnect between calories consumed and body weight. Your blood sugar will be low for most of the day and prevent fat storage. You may have to slowly increase your complex carbs (not starch or sugar) to provide enough fat storage so that you can build muscle. It seems that you have used up some of your muscle for energy -- you are mimicking a diabetic without insulin.

It would be interesting to see your blood work. You might still have a vitamin D deficiency, otherwise, I would expect to see very low inflammation.

It may be that your high omega-3's are sufficient to make muscle gain harder. It would be interesting to see how your upper body would respond to a weight training program.

Dr. A,I am currently undergoing analysis by an endocrinologist referred to by my GP. I may have a hormone issue. When I have the results I'll post them, which should be Wednesday. I have had comprehensive blood tests, chest x-ray and have an ultrsound scan tomorrow on my abdomen and pelvis.I know I am thin, but so far as complex carbs go, I really don't want to add them. I am trying to be as paleo as possible, so legumes are not a choice, and grains are also a no no.I am fit and healthy with a good immune system.I feel I have lot's of stamina but relatively low strength, especially upper body and I am working on this.

Dr. Ayres said "It seems that you have used up some of your muscle for energy -- you are mimicking a diabetic without insulin."

I subscribe to Art De Vany's website and he says that there is fat in muscle, which is essentially the last fat to go when on a paleo diet. Muscle strength is not compromised by this. It means that somebody following an EF regime, (Evolutionary Fitness) may observe a reduction in muscle mass, even though gaining strength, because of the fat reduction in the muscle tissue.I just don't seem to have the capacity or inclination, physically, to perform short, high intensity workouts.

I believe that I have a hormone issue. Hopefully this will be confirmed soon.

My first thought on reading this was, wow, that's a *lot* of walking and not very much weight-bearing exercise. No wonder upper body strength could use some improvement.

I'd noticed some loss of lean muscle mass for both my husband and I due to lack of exercise and aging (ages 47 & 54). Neither of us likes ot exercise for the sake of exercise, but obviously our gardening, home projects, and family activities aren't enough to maintain our muscles now.

We're both enjoying very much the benefits from the at-home version of Fred Hahn's Slow Burn weight training exercises (his book was co-authored with Drs. Mary Dan & Mike Eades). Inexpensive basic equipment for the home routine will work fine and doesn't take up much space. I like that the routine is fast - about 30 minutes, twice a week, which allows time for muscle recovery and repair and reduces time-drain going to a gym.

You might find this type of super slow weight lifting routine to be of benefit. Just a thought.

And Taubes & Eades discuss thermogenesis as a possible explanation how burn those excess fat calories burn off when insulin levels are low.

If I drop my fat intake too low (I low carb, too, for impaired BG management) then I become very lethargic. I need a lot of fat. I don't gain weight with a high fat intake (though I tend towards naturally saturated fats instead of EVOO). But too many carbs pack on water weight gain, then fat storage gain right away, not to mention the 2nd phase insulin response eventually drives my BG hypo...

Dr. Ayres,I saw my GP today and unfortunately the paperwork for the test results had not arrived. He will contact me to see him, when the results are available. I'll post, as and when.The good news for me, is that I have been prescribed testosterone replacement therapy in a gel, Tostran. I start applying tomorrow.I am hoping that this is the missing piece in the jigsaw, and the treatment will make a difference to my lean muscle mass and strength.

I would be happy if you could explain more about cereals at breakfast. I usually eat a bowl of muesli and milk, a skimmed yoghurt and a cup of coffee with honey (I am Italian...love coffee!)I choose my muesli avoiding the most advertised ones, usually full of chocolate or similar stuff.My goal is to eat some carbs with the lowest Glycemic Index. Since I started this approach, I must admit that things are fine, I get to 1 pm with a bit of appetite (I have another yogurt or a couple of fruits as mid-morning snack). I do not feel sleepy after it (possible sign of excess in carbs)Overall, breakfast may be the meal where I have the highest carbs intake.Do you think that also this type of breakfast is unhealthy? What type of cereals you were referring to? Would you include also muesli?

Sovietico,I don't think that it is desirable to eat grain-based carbs, especially at breakfast. The coarser grains are less glycemic, but it seems to make more sense to avoid them.

I like to walk out into my garden with a pair of scissors and snip off some herbs or lots of chives and add those to some stewed tomatoes and a poached egg. Add some olive oil and spices (tumeric, black pepper, tabasco), warm as desired and it's breakfast.

The other comments for this post have lots more info on grains and carbs.

what would you think of a diet of 700 g. of smelt (small fish eaten whole) fried in olive oil in the morning, and 1kg. of steamed scallop with persimmon vinegar in the evening(male, 5'7'', 140 pounds, 14 % of bf)too much food?

Someone else is probably more competent to see if there are obvious problems with that diet. I think it should be basically healthy, but I would add some veggies for variety. Any saturated fat would be better for frying than olive oil, but a drizzle of peppery extra virgin olive oil would go well with either sea food. Spices and herbs would also be good additions. I would follow recipe suggestions from areas where smelt and scallops make up a large part of the diet.

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Thank you for your fascinating reports and taking the time to answer questions!

I recently listened to Dr. Robert H. Lustig's lecture on sugar/fructose ("Sugar: The Bitter Truth"; URL below), and one of the take-away points was that the fructose in fruit is not toxic to the body as it's combined with fiber. Do you agree with him on this point?

Consider this about fruit: I have a Valencia orange tree in my garden. It takes 3 or 4 oranges (with a non-motorized gear/lever juicer) to make just one very small glass of OJ, about 6 oz.

When people drink OJ, how much are they drinking? Generally it's not in the tiny juice glasses of yesteryear - it's 8-12-16-20-24+ oz, right? It takes a LOT of oranges to produce that much juice, and the juice is primarily water and sugar. The fiber may be on aspect why whole fruit is better than processed fruit, but I think there's more to it.

Industrial orange pressing is probably a bit more efficient than I am at extracting out every last bit of OJ, but still, that's a LOT of orange sugar to gulp down. I don't know anyone who eats that many oranges in one week, let alone in one meal or snack.

By the way, I'm reading a book called Squeezed: What You Don't Know ABout Orange Juice, by Alissa Hamilton. It's not the most exciting food industry book, because a LOT of it is 1960s accounts of FDA testimony on proposed standardization of the orange juice industry, but as an allegory for industrial food in general, it's fascinating.

Ask most people and they will tell you OJ is a healthy, relatively unprocessed food. They have no idea what goes into creating tasty orange juice that travels well and stays "fresh" (I use that term loosely). Even if it's "not from concentrate" it's a far cry from the simple juice we can squeeze from whole oranges at home, I can tell you that.

Same goes for fluid milk and most dairy products. The places where these food products are processed look like oil refineries for a reason.

Thank you, for your thoughts, Anna. My question for Dr. Ayers, however, is specifically about whether the fiber in whole fruit protects the body from the damage of fructose. (This is what Dr. Robert H. Lustig suggests in his lecture.)

Kim,I think that Anna is correct. Fructose and alcohol are metabolized similarly in the liver and too much of either can result in fatty liver. Below the level of moderation, neither has a big impact. The body is robust.

I can't think of an obvious way that soluble fiber, e.g. pectin, would alter liver metabolism of fructose/alcohol. Perhaps the short chain fatty acids that are the products of gut flora metabolizing soluble fiber, alter the metabolism of the liver?

I think Dr. Lustig is just using (or confusing?) fruit fiber as a "marker" for unprocessed fruit consumption as well as fruit consumed in small amounts, which generally aren't a problem.

After all, for most people, it's hard to over-consume fructose from whole fruit for prolonged periods (though there are exceptions - I personally know two very obese person who eats mostly whole fruit with some veggies and a small amount of low fat protein).

On the other hand, it's very, very easy to over-consume fructose from processed and concentrated fruit (little or no fiber content). Kids who drink bottled 100% fruit juice or a lot of "fruit leather candy" come to mind.

Like the "Sat Fat is unhealthy" dogma, researchers in other fields too often blindly accept the "fiber is always a good thing" dogma, without checking the data themselves. Personally I tend to take statements about fiber with a grain of salt, unless they are substantiated (as Dr. Ayers does on this blog).

Thank you both for thoughtfully replying to my post. Good thinking all around!

If you get a chance to watch Dr. Lutig's lecture (I'll repost the URL below), I'd love to hear your responses. I found it fascinating and smart, and think you two would be in good company listening to him.

I saw Lustig's video some time ago (I'm a UCTV and UTunes junkie - great for folding laundry or similar mundane tasks). He explains the biochemistry quite well in an engaging manner, and I agree - well worth the time to watch. I love his phrase, "beer without the buzz"! I shook my head at a few minor points he made, though, including the one about the fiber. I think he is missing the plot on that one.

Karen,Most breakfast foods, e.g. cereals, are just modified forms of starch that are quickly converted into spike in blood sugar and produce a day's worth of hunger. I think that a cup of coffee with cream is preferable and more healthy than corn flakes or oat meal. The grain fiber is also unhealthy. Oats have some soluble fiber, but that doesn't compensate for all of the starch/sugar.

Eggs and bacon, or plain full fat yogurt with live bacteria, would be a much better breakfast. Avoid the fruit juices (just sugar water) and toast (starch/sugar).

So Ive been doing alot of research on the topic of male pattern baldness. I have thin hair and I want to prevent possible baldness in the future (the hereditary kind if possible). Currently I am eating an anti-inflammatory diet and do heavy resistance training 2 times a week. I have very little body fat and have high levels of energy. Ive read alot of information from this site about possible supplementation and lifestyle interventions: http://www.hairloss-research.org/updates.html

I just wanted to point out that I have indeed gained weight on an extremely low carb diet. It's happened to me a couple of times. It seems to coincide with times when eating very low carb, high fat doesn't decrease my appetite as it usually would. A month ago I went two weeks eating zero starch, zero sugar, almost zero fruit (also Paleo/non-inflammatory), and my appetite simply wouldn't go away. I definitely gained a few pounds from all the bacon, cheese and butter. Very low carb doesn't always work for weight loss. This used to be a sure-fire way for me to drop pounds, but sadly it's not so reliable for me anymore. I typically eat a fairly low carb diet already. Maybe my body's adjusted to this way of eating and found some new pathway for weight gain that doesn't involve insulin. Maybe a leptin issue.

Wow what a terrific blog I stumbled onto here! I am a bit concerned about a number of comments here regarding use of olive oil. If I remember correctly, it has and Omega 6:3 ratio of about 10:1. Far from the worst among oils, but still presumably far from healthy. Any comments. I would love to eat lots of olive oil but I am trying to avoid excess omega 6. I have been trying to fry in coconut oil but am not thrilled with the taste. Eliminating oils makes salad dressing a challenge, unfortunately.

Listen to my podcast on Jimmy Moore's Livin' La Vida Low Carb Show

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About Me

I grew up in San Diego and did my PhD in Molecular, Cellular and Developmental Biology (U. Colo. Boulder). I subsequently held postdoctoral research positions at the Swedish Forest Products Research Laboratories, Stockholm, U. Missouri -Colombia and Kansas State U. I was an assistant professor in the Cell and Developmental Biology Department at Harvard University, and an associate professor and Director of the Genetic Engineering Program at Cedar Crest College in Allentown, PA. I joined the faculty at the College of Idaho in 1991 and in 1997-98 I spent a six-month sabbatical at the National University of Singapore. Most recently I have focused on the role of heparin in inflammation and disease.